Neighborhood Economic Development Corporation 12 North Center Street, Mesa, Arizona (480) FAX (480)

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1 Neighborhood Economic Development Corporation 12 North Center Street, Mesa, Arizona (480) FAX (480) LOAN APPLICATION: Part C Business Loan Programs, Mesa, Arizona PLEASE PRINT or TYPE CLEARLY! INCOMPLETE AND ILLEGIBLE FORMS WILL NOT BE PROCESSED. APPLICATION # (FOR OFFICE USE ONLY) SECTION ONE: ADVANCED BUSINESS INFORMATION FORM Your Name: Business Name: Business address (Main office/plant/store location): Other Locations: Your Phone (with area code): Cell Phone: E mail Address: Website: Description of product/service: Years in business? Organizational Structure: Sole Proprietorship Partnership S Corporation C Corporation LLC Other: Do you own other businesses? No Yes List/describe: Locations: Projected Gross Receipts, Monthly $ Net Profits, Yearly, actual: $ Projected Gross Receipts Yearly: $ Net Profits, Yearly, projected: $

2 NEDCO Loan Application: Part C Business Information Page 2 IMPORTANT: If you are projecting gross receipts and net profits, because your business is a start up, attach your business plan with its financial projections. If you are already in business and there are actual sales, attach your financial reports (Profit and Loss and Balance Sheet). These must include year end financial reports (actual audits preferred) for the two most recent completed fiscal years even if there is a partial fiscal year AND monthly reports for each month following the fiscal year end to the date of this application. Whether or not your business is organized as a sole proprietorship, you MUST attach copies of three years of tax returns including Schedule Cs and all attachments, if applicable. What changes in your gross receipts/net profit are expected as a result of obtaining a loan? You may refer to a Business Plan, and attach it. If the business plan does not answer this question specifically, please use extra sheets if necessary. SECTION TWO: YOUR WORK FORCE Number of employees? Full-time Part-time Seasonal (include yourself only if you receive a regular salary) Others such as contracts: Please attach sheet with names, addresses, salary, employment location and employment date for all current employees. Number of employees to be hired as a result of obtaining a loan: Full-time Part-time Seasonal Other: (Explain) What changes to your workforce do you expect as a result of obtaining the proposed loan?

3 NEDCO Loan Application: Part C Business Information Page 3 Note: Loans provided by NEDCO, a community development loan fund, are expected to meet national objectives to create or retain jobs with an emphasis on jobs for low and moderate income persons. Investment and stable employment are indicators of improved community and business sectors. Therefore, we must inquire specifically about your hiring plans. Should your business receive a loan, you will be certifying that you will make at least 51% of your business new jobs available to persons of low/moderate income (either through your efforts or Workforce Connections) and you will be required to keep and provide data on your applicants and hires which supports this assertion for the term of the loan or up to three years. Please attach a sheet with job titles, full or part time expected, salary expected to be paid, short job description, employment location and a short outline of your advertising plan for hiring for each position. If you have personnel policies which describe these methods, please attach. If you are starting up and have no employees as of the date of this application, estimate when at least you yourself, as the entrepreneur, will begin to receive a salary and answer the question from that perspective. If you have any questions completing this section of Part B, please call or e mail NEDCO. NEDCO asks you to sign a form with the application which states that you are available to participate in surveys on your business which NEDCO is required to perform in order to have access to the capital for your loan

4 SECTION THREE: LOAN REQUEST 1. LOAN AMOUNT: Amount requested: $ Term: 6, 12, 18, 24, 30, 36 month; Other: 2. OTHER FINANCING COMMITTED: Describe: Lender: Terms and Conditions: Lender Contact(s): Name, title, phone and e mail address: Note: Some NEDCO loan programs require participation by another financing entity. All loan guidelines are published on the website; contact NEDCO directly with any questions. 3. YOUR EQUITY (Amount you are putting into the project or have available to put in): Describe your assets available for this project. Note: For most of NEDCO s loan programs, borrowers are required to provide at least 10% of the total project cost either in cash or committed property or other.

5 NEDCO Loan Application: Part C Business Information Page 5 4. DESCRIPTION OF LOAN REQUEST Name the item(s) or service(s), the cost(s), the origination [where you will obtain the item(s)/service(s)], If they are new or used, and the benefit of the item(s)/service(s) to your company, as a result of this loan. Description/ Equipment: Cost New/Used Benefit Working Capital (list specific needs): General Start-up Expenses (List specific needs): Real Estate: Other:

6 NEDCO Loan Application: Part C Business Information Page 6 5. SOURCE OF REPAYMENT AND COLLATERAL Provide a brief summary and validation of how the item(s)/service(s) will help your business generate additional revenue that can pay back the proposed loan. Be specific. Please provide a statement as to the collateral that you have for the repayment of the proposed loan if the business performance does not meet projections. For example, a second mortgage is available on your home; you have savings, you have a cosigner with significant assets, you have other property that is available to be pledged, etc.

7 NEDCO Loan Application: Part C Business Information Page 7 I hereby certify that the foregoing information is true and complete to the best of my knowledge. These statements are made for the purpose obtaining or guaranteeing a loan. I/We hereby authorize NEDCO to make inquiries as necessary to verify the accuracy of statements made herein and to determine my creditworthiness. Applicant s Signature: Date: Co-Applicant s Signature: Date: IMPORTANT: YOU MUST COMPLETE PARTS A, B AND C OF THE LOAN APPLICATION. Please see instructions and call NEDCO with any questions. Neighborhood Economic Development Corporation: Office Use Only NEDCO has reviewed this Application and has confirmed that, by an analysis of completed Parts A, B and C as well as a review of credit, the proposed Borrower(s) is/are eligible to make this Application under the Guidelines of its Business Loan Programs and that Borrower(s) has remitted the required Application Fee. NEDCO will provide technical assistance and support as appropriate to the Application and the loan proposed herein. Date: Business Coach or Authorized NEDCO Representative NEDCO Executive Director (Loan Manager) Date: Distribution: Original Loan Application (all parts) to NEDCO Copies of Loan Application to Applicant

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